Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA.
Department of Medicine, Texas Christian University School of Medicine, Fort Worth, Texas, USA.
AJOB Empir Bioeth. 2023;14(4):227-236. doi: 10.1080/23294515.2023.2224589. Epub 2023 Jun 21.
Medical students receive a varying amount of training in medical ethics and are expected to navigate clinical ethical dilemmas innately. There is little literature on attempts to navigate ethical dilemmas experienced during early clinical experiences and whether current curricula prepare students for these dilemmas. This study explores the different ethical dilemmas experienced by medical students on their third-year clerkships and analyzes the factors, sources, and resolutions proposed by them.
From 2016 to 2018, third-year medical students completed a written assignment to describe, analyze, and reflect on a clinical situation in which they experienced an ethical dilemma. They identified specific ethical dilemmas present, potential preventative and aftermath solutions, and reflected on their professional development from their experience. The research team utilized applied thematic analysis to identify themes and patterns in the data. A thematic matrix was utilized to examine similarities and differences across medical students.
Of the 162 reflections, 144 (88.9%) students indicated an ethical dilemma that included issues related to autonomy and beneficence. Of these, 116 (71.6%) students found the two ethical principles in direct conflict. Students identified three common sources of this conflict: lack of communication; unclear understanding of clinical policies regarding family authority and psychiatric capacity; and medical negligence. Lastly, students suggested different solutions for dealing with and preventing this conflict.
Our findings suggest that an overwhelming number of students face ethical challenges when confronted with medical situations that raise conflicts between autonomy and beneficence. Their recommended solutions reveal an appeal among students to have tools and strategies in place to ease the need to make difficult decisions. Medical students might be better served by learning about the complexities of ethical decision-making and the likelihood of experiencing moral distress when they feel an inability to implement what they envision as the best solution.
医学生接受了不同程度的医学伦理学培训，并被期望本能地解决临床伦理困境。关于尝试解决早期临床经验中遇到的伦理困境以及当前课程是否为学生做好这些困境的准备，文献甚少。本研究探讨了医学生在三年级实习期间遇到的不同伦理困境，并分析了他们提出的这些困境的因素、来源和解决办法。
从 2016 年到 2018 年，三年级医学生完成了一项书面作业，描述、分析和反思他们在临床经历中遇到的伦理困境。他们确定了存在的具体伦理困境、潜在的预防和后果解决方案，并从他们的经验中反思自己的专业发展。研究团队利用应用主题分析来识别数据中的主题和模式。使用主题矩阵来检查医学生之间的相似点和差异。
在 162 份反思中，144 份（88.9%）学生表示存在涉及自主性和功利性的伦理困境。在这些学生中，有 116 名（71.6%）学生发现这两个伦理原则直接冲突。学生确定了这种冲突的三个常见来源：缺乏沟通；对涉及家庭权威和精神病能力的临床政策的理解不明确；和医疗疏忽。最后，学生们为处理和预防这种冲突提出了不同的解决方案。
我们的研究结果表明，当面对自主性和功利性之间存在冲突的医疗情况时，绝大多数学生都面临着伦理挑战。他们建议的解决方案表明，学生希望有工具和策略来缓解做出艰难决策的需要。当学生感到无法实施他们认为是最佳解决方案时，他们可能会更好地学习关于伦理决策的复杂性和可能经历道德困境的可能性。
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